| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,789 |
1,956 |
$558K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,791 |
1,541 |
$339K |
| D9222 |
|
1,550 |
1,541 |
$218K |
| D7240 |
Removal of impacted tooth - completely bony |
821 |
348 |
$134K |
| D7230 |
|
686 |
383 |
$95K |
| D0330 |
Panoramic radiographic image |
1,590 |
1,589 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,324 |
2,322 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
382 |
98 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$277.20 |